Routine inspection·February 15, 2024

Licensing Program Analyst(LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with and explained the reason for the visit. Facility is licensed to served 99 adults over the age of 60 years old, of which 35 may be non-ambulatory. Facility has a hospice waiver for 4 and the following rooms are cleared for bedridden residents; 102 thru 110, 115 thru 119, and 123. Facility is a two story building with a commercial kitchen, a dining room, an activity room, a courtyard, a medication room, and front porch. No large bodies of water were observed. Sprinkler fire system throughout the facility. Fire extinguishers in hallways in each floor. LPA conducted a tour of the facility and observed the following: Activity area is clean, fireplace is inaccessible to residents. Dining room was observed in good repair and clean. Kitchen was observed clean, storage of food supplies was observed with sufficient perishables for at least 2 days, and non-perishables for 7 days. Kitchen wall behind the stove, was observed caved into the kitchen and with a gap between the floor and the wall the length of more than half the size of the wall and the width of about 3 inches. LPA observed 5 random resident rooms and observed sufficient lighting, furniture, and bedding supplies. Each room has a bathroom and were observed in working condition, with grab bars, and skid mats. Water temperature was tested between 110.6 - 138.3 degrees F. which is not within the required 105-120 degrees F. Shower faucet in room #207 was observed cracked and missing half of the faucet. Ramps, and stairways were observed clear of obstructions. Stairways are missing an evacuation chair. Courtyard provides shaded sitting area, front porch provides sitting area, and back area provides a smoking area. Carbon monoxide/Smoke detectors were tested and are in working condition. Facility stores additional linens, and cleaning supplies were observed in a closet. Sharps are stored in the kitchen and residents do not have access to the kitchen. (CONTINUED ON LIC 809C) LPA reviewed medications for 5 residents, resident #2(R2) was out of prescribed medication filled on 1/25/24 and LVN stated to have been giving R2 additional pills due to R2 requesting it. Per prescription R2 is to have 2 pills per day, LVN has been providing more per day. LPA reviewed 5 resident and 5 staff files. Emergency Disaster plan and Infection control plans were reviewed last reviewed/updated in 2022. A copy of Liability Insurance was provided. Administrator certificate was observed for Lydia Pabion #6006152740 exp: 8/10/25. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Lydia Pabion and a copy of this report, LIC 809D, and appeal rights were provided.